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Volume 357:1977-1978 November 8, 2007 Number 19
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Prophylactic Cranial Irradiation in Small-Cell Lung Cancer

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by Slotman, B.
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To the Editor: The trial reported by Slotman et al. (Aug. 16 issue)1 showed a reduced incidence of symptomatic brain metastases and an improvement in overall survival with the addition of prophylactic cranial irradiation in patients with extensive-stage small-cell lung cancer. Brain imaging was not part of standard staging before randomization unless symptoms suggestive of metastasis were present. Published data suggest that up to 15% of patients have asymptomatic brain metastases, and the prognosis for these patients is similar to that for patients with symptomatic metastases.2,3 Therefore, the benefit of prophylactic cranial irradiation may be less than that suggested because . . . [Full Text of this Article]



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